Vascular Web Logo

SVS  SVS Foundation
A A A
VascularWeb

 PS38. Increased Rate of Myocardial Infarction with Carotid Endarterectomy Under General Anesthesia: A Population-based Study

​Jaime Benarroch-Gampel, Kristin M. Sheffield, Lorraine Choi, Casey A. Boyd, Taylor S. Riall, Lois A. Killewich
Surgery, University of Texas Medical Branch, Galveston, TX.

OBJECTIVES: To determine if the incidence of stroke, myocardial infarction (MI) or death differs in patients undergoing carotid endarterectomy (CEA) under general (GA) vs. locoregional (LRA) anesthesia.

METHODS: A total of 33,291 patients who underwent CEA were identified from the National Surgical Quality Improvement Program (NSQIP, 2005-2010). The association between type of anesthesia (GA vs. LRA) and incidence of perioperative stroke, MI and death was evaluated.

RESULTS: Of the total, 27,844 (83.63%) patients received GA, and were more likely than those who received LRA to have symptomatic carotid disease (43.9 vs. 40.5%, p<0.0001). No difference in baseline cardiovascular comorbidities was seen between groups (42.2 vs. 41.2%, p=0.63). In the overall cohort, 1.51% patients had a stroke, 0.66% had an MI, and 0.60% died within 30 days of surgery. In both the overall cohort and subgroup analyses, the perioperative MI rate was higher in patients who underwent GA compared to LRA (Table). In multivariate models adjusted for patient demographic and clinical characteristics, GA patients were 2.2 times more likely to have an MI compared to those receiving LRA (OR=2.20, 95% CI=1.36-3.58). No differences between groups were found in the incidence of perioperative stroke or death.

CONCLUSIONS: The CREST trial found a decreased rate of perioperative stroke in patients undergoing CEA compared to carotid stenting, but CEA patients had a higher rate of MI. Our finding of a reduced rate of MI in patients undergoing CEA with LRA compared to GA suggests that CEA using LRA may be the safest procedure for patients with carotid artery disease.

AUTHOR DISCLOSURES: J. Benarroch-Gampel, Nothing to disclose; C. A. Boyd, Nothing to disclose; L. Choi, Nothing to disclose; L. A. Killewich, Nothing to disclose; T. S. Riall, Nothing to disclose; K. M. Sheffield, Nothing to disclose.

Unadjusted myocardial infarction rates

SUBGROUPS
GENERAL (N=27,844)
LOCOREGIONAL (N=5,447)
p-Value
Overall cohort
0.73%
0.33%
0.001
Symptomatic carotid disease
0.83%
0.32%
0.01
Asymptomatic carotid disease
0.65%
0.34%
0.03
With cardiovascular comorbidities*
0.93%
0.44%
0.01
No cardiovascular comorbidities
0.58%
0.25%
0.02
*CHF, MI w/in 6m, angina w/in 1m, PCI, cardiac surgery or PVD.

 

Posted April 2012

Contact Us

Society for Vascular Surgery
633 North Saint Clair Street, 22nd Floor | Chicago, IL 60611
Phone: 312-334-2300 | 800-258-7188
Fax: 312-334-2320
Email: vascular@vascularsociety.org

Follow Us

YouTube

VascularWeb® is the prime source for all vascular health and disease information, and is presented by the Society for Vascular Surgery®. Its members are vascular surgeons, specialists, and vascular health professionals who are specialty-trained in all treatments for vascular disease including medical management, non-invasive procedures, and surgery.